Deployment-related stress and trauma in Dutch soldiers returning from Iraq

Engelhard, Iris M.; Hout, Marcel A. van den; Weerts, Jos; Arntz, Arnoud; Hox, Joop J.; McNally, Richard J.

doi:10.1192/bjp.bp.106.034884

Cited by 138 publications

(111 citation statements)

References 25 publications

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“…a Dutch and Belgian community sample of relatives of long-term missing persons), the generalizability of our findings to relatives of missing persons in general, but also people confronted with other loss-experiences, with clinical levels of psychopathology, who are more recently bereaved, and have other cultural backgrounds may be limited. Third, self-report measures instead of diagnostic interviews were used, which may have led to overestimation of psychopathology levels (Engelhard et al, 2007). In addition, we did not take the nested structure of our data (i.e.…”

Section: Discussionmentioning

confidence: 99%

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

Lenferink

Eisma

Keijser

et al. 2017

European Journal of Psychotraumatology

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Background: The disappearance of a loved one is a unique type of loss, also termed ‘ambiguous loss’, which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of missing persons. A potential protective factor is self-compassion, referring to openness toward and acceptance of one’s own pain, failures, and inadequacies. One could reason that self-compassion is associated with lower levels of emotional distress following ambiguous loss, because it might serve as a buffer for getting entangled in ruminative thinking about the causes and consequences of the disappearance (‘grief rumination’). Objective: In a sample of relatives of missing persons we aimed to examine (1) the prediction that greater self-compassion is related to lower symptom-levels of PG, depression, and PTS and (2) to what extent these associations are mediated by grief rumination. Method: Dutch and Belgian relatives of long-term missing persons (N = 137) completed self-report measures tapping self-compassion, grief rumination, PG, depression, and PTS. Mediation analyses were conducted. Results: Self-compassion was significantly, negatively, and moderately associated with PG, depression, and PTS levels. Grief rumination significantly mediated the associations of higher levels of self-compassion with lower levels of PG (a*b = −0.11), depression (a*b = −0.07), and PTS (a*b = −0.11). Specifically, 50%, 32%, and 32% of the effect of self-compassion on PG, depression, and PTS levels, respectively, was accounted for by grief rumination. Conclusions: Findings suggest that people with more self-compassion experience less severe psychopathology, in part because these people are less strongly inclined to engage in ruminative thinking related to the disappearance. Strengthening a self-compassionate attitude using, for instance, mindfulness-based interventions may therefore be a useful intervention to reduce emotional distress associated with the disappearance of a loved one.

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Section: Discussionmentioning

confidence: 99%

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

Lenferink

Eisma

Keijser

et al. 2017

European Journal of Psychotraumatology

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“…That is, these subjects may misunderstand the meaning of emotional numbing, flashbacks, and so forth, confusing normal reactions with psychopathology. Questionnaires can overestimate clinically diagnosable PTSD, even among war veterans [12].…”

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confidence: 99%

Risk factors and posttraumatic stress disorder: are they especially predictive following exposure to less severe stressors?

McNally

Robinaugh

2011

Depress. Anxiety

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Background: The diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic stressor, as defined by Criterion A in the DSM criteria for PTSD. Yet, over the course of successive revisions of the diagnostic manual, the range of qualifying stressors has expanded considerably (e.g., watching terrorist attacks on television). Moreover, stressors that fall short of qualifying for even an expanded Criterion A can produce apparent PTSD. Taken together, these findings imply that people who do satisfy symptomatic criteria for PTSD following exposure to less severe stressors carry a heavy burden of risk factors. Method: To test this hypothesis, we examined whether the association between the risk factor of lower intelligence and more severe PTSD and depression symptoms would be greater among women reporting less severe CSA (n = 15) relative to women who reported moderate (n = 54) or high (n = 31) severity CSA. Results: The evidence was consistent with this hypothesis for subjects in the low and moderate severity groups, but less so for those in the high severity group. Conclusions: Lower intelligence was a more potent risk factor for posttraumatic distress among people exposed to less severe relative to moderately severe stressors. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.

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“…same cause and circumstances of the loss), (3) the focus on three outcome measures (tapping symptoms of PGD, PTSD, and depression), (4) the preliminary evaluation of possible mechanisms of change of the treatment, and (5) process-monitoring of changes in PG levels on micro-level using session-by-session assessments. One of the limitations of this study is the reliance on self-report measures, which may overestimate symptom levels (Engelhard et al, 2007). In addition, we will assess baseline data at one time point, which may lead to overestimation of treatment effects due to regression toward the mean of participants with extreme scores (Biglan, Ary, & Wagenaar, 2000).…”

Section: Discussionmentioning

confidence: 97%

Cognitive therapy and eye movement desensitization and reprocessing for reducing psychopathology among disaster-bereaved individuals: study protocol for a randomized controlled trial

Lenferink

Piersma

Keijser

et al. 2017

European Journal of Psychotraumatology

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Background: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss. Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand. Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used. Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.

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Deployment-related stress and trauma in Dutch soldiers returning from Iraq

Abstract: There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD.

Cited by 138 publications

References 25 publications

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

Risk factors and posttraumatic stress disorder: are they especially predictive following exposure to less severe stressors?

Cognitive therapy and eye movement desensitization and reprocessing for reducing psychopathology among disaster-bereaved individuals: study protocol for a randomized controlled trial

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